Adrenal POTS is a complex condition that affects the body’s stress response and blood pressure regulation. This disorder, a subset of postural orthostatic tachycardia syndrome (POTS), has a connection to the adrenal glands and cortisol levels. Understanding the link between adrenal POTS and high cortisol can help patients and healthcare providers manage symptoms more effectively.
This article explores the nature of adrenal POTS, its relationship with cortisol, and how it differs from other forms of POTS. We’ll look at the diagnostic process for adrenal POTS, including symptoms to watch for and tests used to confirm the condition. Finally, we’ll discuss treatment approaches, from lifestyle changes to medications, that can help people with adrenal POTS improve their quality of life.
What is Adrenal POTS?
Definition and symptoms
Adrenal POTS, a subset of postural orthostatic tachycardia syndrome, is characterized by an overactive stress response and blood pressure regulation issues. This condition has a connection to the adrenal glands and cortisol levels. Patients with adrenal POTS often experience symptoms such as constant fatigue, brain fog, diminished immune response, and problems with low blood pressure. They may also have difficulty coping with stressors and feel most energetic in the evenings.
Differences from other forms of POTS
Adrenal POTS differs from other forms of POTS in its underlying mechanisms. While neuropathic POTS involves lower blood pressure and higher heart rate when standing, adrenal POTS, also known as hyperadrenergic POTS, often presents with both increased blood pressure and heart rate upon standing 1. This distinction is due to the high levels of norepinephrine in the blood of patients with adrenal POTS.
Role of the adrenal glands
The adrenal glands, located atop the kidneys, play a crucial role in the body’s stress response. They receive signals from the pituitary gland in the brain and help control inflammation by releasing cortisol. In adrenal POTS, the adrenal glands may not function optimally, leading to abnormal levels of cortisol and norepinephrine. This disruption in the body’s ability to maintain homeostasis can result in various symptoms associated with the condition.
The Connection Between POTS and Cortisol
Normal cortisol function
Cortisol, a steroid hormone produced by the adrenal glands, plays a crucial role in regulating the body’s stress response. It affects various aspects of bodily functions, including metabolism, inflammation suppression, and blood pressure regulation. Under normal circumstances, cortisol levels follow a circadian rhythm, with peak levels in the morning and lower levels in the evening, helping to maintain the sleep-wake cycle.
How cortisol levels are affected in POTS
Research has shown that cortisol levels are significantly higher in patients with postural orthostatic tachycardia syndrome (POTS) compared to healthy individuals. A study found that cortisol levels in POTS patients were 160.17±pg/ml, while in the control group, they were 69.65± 5.8pg/ml, with a p-value of 0.023 2. This elevation in cortisol levels suggests a dysregulation of the hypothalamus-pituitary-adrenal axis in POTS patients.
Impact of high cortisol on symptoms
The increased cortisol levels in POTS patients have a significant impact on their symptoms. High cortisol can lead to persistent high blood sugar (hyperglycemia), which may contribute to the fatigue and exercise intolerance experienced by POTS patients. Additionally, elevated cortisol levels have been associated with the severity of POTS symptoms 2. The constant state of heightened stress response can exacerbate other symptoms such as tachycardia, lightheadedness, and dizziness.
It’s important to note that while cortisol plays a role in POTS, it is not the sole factor. Other hormones and systems, such as the renin-angiotensin-aldosterone system, also contribute to the complex pathophysiology of POTS. Understanding these mechanisms can lead to more effective treatment approaches for managing adrenal POTS and its associated symptoms.
Diagnosing Adrenal POTS
Cortisol testing methods
Diagnosing adrenal POTS involves assessing cortisol levels, which can be measured through blood, saliva, or urine tests. Blood samples are typically collected in the morning when cortisol levels are highest. Saliva tests may be conducted at home, with late-night samples often used to check for high cortisol levels. For urine tests, patients collect all urine over a 24-hour period 3.
Other diagnostic criteria
A key diagnostic criterion for adrenal POTS is an increase in heart rate of 30 beats per minute or more within the first 10 minutes of standing, without a significant drop in blood pressure 4. This can be assessed using either a 10-minute standing test or a head-up tilt table test. Additional tests may include the Valsalva maneuver to evaluate autonomic nerve response and the quantitative sudomotor axon reflex test (QSART) to measure sweating regulation 4.
Differentiating from other conditions
Distinguishing adrenal POTS from other conditions can be challenging due to overlapping symptoms. Conditions such as chronic fatigue syndrome, inappropriate sinus tachycardia, and anxiety disorders may present similarly 5. It’s crucial to rule out other potential causes of orthostatic intolerance, such as anemia, thyroid dysfunction, or medication side effects. A thorough medical history, physical examination, and basic laboratory tests, including complete blood count, electrolytes, and thyroid function tests, are essential in the diagnostic process 5.
Treatment Approaches for Adrenal POTS
Lifestyle modifications
Managing adrenal POTS often begins with lifestyle changes. Patients are encouraged to increase their daily salt intake gradually, aiming for 10-12 grams per day, along with increasing fluid intake to 2-3 liters daily 6. This helps expand blood volume and improve symptoms. Exercise is crucial for reconditioning the cardiovascular system. A structured program, starting with horizontal exercises like swimming or recumbent cycling, can be beneficial 7. The Levine Protocol, a 3-month exercise program, has shown efficacy in lowering heart rates and improving cardiac output in POTS patients 8.
Compression garments, particularly those extending to the upper abdomen, can help reduce blood pooling in the legs and improve venous return 6. Dietary modifications, such as consuming smaller, more frequent meals and increasing fiber intake, may alleviate gastrointestinal symptoms often associated with adrenal POTS 8.
Medications
While there are no FDA-approved treatments specifically for adrenal POTS, several medications are used off-label to manage symptoms 8. Beta-blockers, such as propranolol, are commonly prescribed to reduce heart rate and improve symptoms, especially in hyperadrenergic POTS 9. Fludrocortisone, a synthetic version of aldosterone, can help increase blood volume and is often recommended for patients with low blood pressure 9.
For those who cannot tolerate beta-blockers, ivabradine may be an alternative. It slows heart rate without affecting blood pressure and may be particularly useful in hyperadrenergic POTS 8. Midodrine, a vasoconstrictor, can be effective in patients with low blood pressure and pronounced orthostatic intolerance 9.
Addressing cortisol imbalances
In adrenal POTS, addressing cortisol imbalances is crucial. While the adrenal gland response to adrenocorticotropic hormone (ACTH) appears intact in POTS patients 10, managing stress and regulating cortisol levels remain important. Stress reduction techniques, such as mindfulness practices and gentle stretching, can help balance the autonomic nervous system 6.
Conclusion
Adrenal POTS and its connection to high cortisol levels shed light on the intricate workings of our body’s stress response and cardiovascular regulation. By understanding this link, healthcare providers can offer more targeted treatments, combining lifestyle changes, medications, and stress management techniques to improve patients’ quality of life. This holistic approach acknowledges the complex nature of the condition and aims to address its various aspects.
Moving forward, continued research into adrenal POTS and cortisol’s role will likely lead to more refined diagnostic methods and treatment strategies. For those grappling with this condition, seeking specialized care is crucial. At Hope Brain and Body in Chadds Ford, we offer personalized treatment using Functional Medicine. To explore your options, reach out to our team at Hope Brain & Body on (610) 652-4732 and schedule a visit to our offices in Chadds Ford, Pennsylvania. With ongoing advancements in understanding and managing adrenal POTS, patients can look forward to better symptom control and an improved overall well-being.
FAQs
Does POTS impact cortisol levels?
Cortisol levels are indeed higher in individuals with POTS compared to those with Vasovagal Syncope (VVS), although the difference is not significant enough to be used for differential diagnosis. Additionally, no relationship was found between age, number of syncopal episodes, and cortisol levels in either the POTS or VVS groups.
Can adrenal glands be a reason for elevated cortisol levels?
Yes, elevated cortisol levels can originate from the adrenal glands. A common cause is Cushing’s syndrome, which can occur when there’s an excess production of cortisol, often due to a tumor in one of the adrenal glands.
What is the primary cause of elevated cortisol levels?
The most frequent cause of high cortisol levels is a condition affecting the adrenal glands, such as a non-cancerous tumor known as an adrenal adenoma, which can lead to overproduction of cortisol.
What symptoms are associated with high cortisol levels from the adrenal glands?
High cortisol levels can lead to specific symptoms including weight gain, particularly around the face and abdomen, fatty deposits between the shoulder blades, wide purple stretch marks on the abdomen, muscle weakness in the upper arms and thighs, and elevated blood sugar levels, which may progress to Type 2 diabetes.
Can chronic stress and anxiety affect adrenal function related to POTS?
Chronic stress and anxiety might impact adrenal function, potentially influencing conditions like POTS. The adrenals regulate heart rate and their impaired function due to chronic stress could plausibly contribute to symptoms associated with POTS, such as orthostatic hypotension or an increased pulse rate upon standing. However, the medical community has not definitively confirmed this connection, and it remains a topic of ongoing research and discussion.
References
[1] https://www.reddit.com/r/dysautonomia/comments/5oec4m/can_pots_be_linked_to_the_adrenals_in_some_people/
[2] – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8713199/
[3] – https://www.testing.com/tests/cortisol/
[4] – https://www.hopkinsmedicine.org/health/conditions-and-diseases/postural-orthostatic-tachycardia-syndrome-pots
[5] – https://www.ccjm.org/content/90/7/439
[6] – https://www.rupahealth.com/post/a-functional-medicine-approach-to-pots
[7] – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6289756/
[8] – https://www.uscjournal.com/articles/narrative-review-postural-orthostatic-tachycardia-syndrome-associated-conditions-and
[9] – https://www.standinguptopots.org/resources/medicine
[10] – https://www.sciencedirect.com/science/article/abs/pii/S1566070223000346